Walrus Talk – March 21, 2016

My name is David Goldbloom and I’m a psychiatrist in Toronto at the Centre for Addiction and Mental Health and Professor of Psychiatry at the University of Toronto. And I’m here to ask you an important question about mental health in our country: What will it take?

Let me start with a simpler question: How many of you know someone – in your family, your circle of friends, your neighbourhood, school, or place of work – who’s experienced mental illness? Hands up! How many of you know someone in those same spheres who died by suicide? Take a look around the room. How many of you think the status quo around mental health in Canada is acceptable? What will it take?

In 2007, as I waited to speak to a room much like this, a friendly woman sat down next to me, introduced herself, and asked me the most terrifying question I know: How do you like my new haircut? As I stammered, she explained that she had had breast cancer a year earlier, and her long hair had fallen out with treatment and had just regrown to a pixie-ish length. I said to her that we had just met 90 seconds earlier but she felt comfortable telling me she had had breast cancer, surgery, chemo and radiation. I asked if she would have been so candid if she had been depressed last year. She replied, “Absolutely not”. Despite the fact she knew depression – and her husband had been hospitalized for it. What will it take?

In the last decade, the landscape has been shifting. With Bell Let’s Talk, with The Jack Project, and with the candour of people like Romeo Dallaire, Clara Hughes and Margaret Trudeau, the conversation is opening up. But the shame and the secrecy persist. The obituary of a young person that says “died suddenly” and no disease charity is named remains our newspaper code for suicide, and only rarely do we see “lost a courageous battle” with depression or schizophrenia the way we see for cancer or other potentially fatal illnesses. What will it take?

In Canada, very recent research by Calgary’s distinguished psychiatrist and epidemiologist Scott Patten has compared depression in 2012 versus 2002. There has been no change in the frequency of this illness in a decade – only greater awareness. But in 2012, 10% more of depressed Canadians had 6 or more visits in the year with any health professional about their mental health – with a family doctor, psychiatrist, psychologist, nurse, social worker, counsellor, psychotherapist. Good news, right? Except that it was only 40% of depressed Canadians in 2012 who received ongoing help in this way. About one-third of these depressed Canadians in 2012 were receiving antidepressants – no change from 2002. The data are different than the perception that “everyone I know is on an antidepressant”. Put them together, and the authors speculate that perhaps 50% of depressed Canadians are receiving POTENTIALLY adequate care. How would you react to the good news that 50% of Canadians with cancer receive potentially adequate care? What will it take?

In Ontario, a study of the burden of disease – measured by years lived with disability and years lost due to premature death – showed that the burden of mental illnesses was 1.5 times all cancers combined and 7 times all infectious diseases combined. How is that reflected in the way we allocate resources to help affected individuals and their families?

Across Canada, about 6-7% of all health dollars spent go to mental health. In other countries, like the UK and New Zealand, the range is more like 11-13%. And some of that goes to needed innovation in how we deliver mental health services. Simply increasing the number of psychiatrists is not the answer. The Mental Health Commission of Canada, in its 2012 national mental health strategy, called on governments at the federal, provincial and territorial level to raise spending on mental health to 9% of health dollars over ten years. What will it take?

In the UK, since 2008 a program called Improved Access to Psychological Therapies has, through the public purse, provided citizens with evidence-based psychotherapy that matches need to expertise and intensity. Over 2 million people have been treated – outside the traditional mental health system. In Australia, family doctors can refer patients for publicly funded cognitive behavioural therapy from psychologists, recognizing the roles of a variety of providers in healthcare. Internet-based psychotherapies overcome barriers of geography and cost in a different way – but one that is highly relevant to our massive country. What will it take?

Here are the facts: One in five Canadians every year experiences some form of mental illness – and it’s not the same one in five each year. It’s like when they tell you that in Manhattan, a person is hit by a car every 11 seconds, don’t think “that guy should get out of town”. It’s about a vulnerability we all share. Every day in Canada, half a million people are away from their jobs due to mental illness. It’s the leading cause of disability in the Canadian private and public sectors. And it costs the Canadian economy more than $50 billion per year. Some Canadians are heated up about a planned federal deficit. Where is the heat about this ongoing deficit due to mental illness, not to mention the unmeasurable cost to the dignity, functioning and quality of life of people with mental health problems and illnesses and their families. What will it take?

In my view, it will take more than government. It will take all of us being galvanized to speak openly to our families, friends and colleagues about a common human experience, to demand better services and supports, with a broad view of the determinants of health, as well as the necessary research to improve understanding and treatment. There are many examples for Canada to follow; what will it take for Canada to lead?

 

This presentation was part of a panel discussion on mental health hosted by The Walrus Foundation.